18 October 2010

The guy in room 8 was a drunk, "just another drunk." It sounded like he was pretty hardcore -- homeless, been living on the street for a while, refused at the mission. The story sounded benign: he had been sleeping in a bush somewhere, and some Good Samaritan had called the ambulance, but he denied trauma or any other problem. Just had so much to drink that he wasn't able to get back to his regular spot under the bridge. Alcohol level somewhere north of 300.

I was a little curious, though, because a quick review of the records showed that he hadn't been in our ER before. Most of the resident homeless alcoholics in our community stop in the ER every so often, if only for a laceration or a sammich once in a while. And I also noted that his age was 75 years old. That's a remarkable feat of longevity for someone living on the street. So when I saw him, I was a little more inquisitive than usual, just to be sure I had constructed the narrative correctly.

I had. He was not exactly new to our community; he had been staying in the local jail for six months. Prior to that he had been living on the street in a town a bit further south. But once released, he hadn't bothered to go back "home" since one bridge is much like another. So he stayed in our fair city instead. He was surprisingly cheerful in spite of it all.

He looked wiry and weather-beaten, someone who knows how to survive on the street, but also frail and vulnerable due to his age. While he was clearly expecting to be discharged back out, I was a little apprehensive about letting him go on his own. I probed -- "Do you have any family? Anyone local that you could stay with for a while?"

He considered for a moment. His face darkened, just briefly, and he responded, "No. No family."

That made me sad. We discharged him once he was ready -- there weren't any other good options. He had no acute medical needs to justify an admission. We used to have some detox beds but once the recession hit, social services were slashed to the bone, so that's not available any more. There are some local charities, but quite frankly they are not equipped to handle someone like him, and I'm not actually sure that he was interested in any "treatment" at this point.

But I reflected, as I completed his chart, after he left, on that moment of hesitation before he said he had no family, no friends, nobody on this earth that he could look to for help. He had considered the question. Clearly he was going through a mental checklist of his own, remembering all the people that he once had relations with before he decided all of those doors were closed to him. Seventy-five years alive and all alone. What a tragic legacy. What were the stories to be told there? Estranged spouses and girlfriends? Children, now grown, who longer wanted anything to do with him? Or had he somehow, improbably, outlived them all? Was he the survivor in his small social circle? That's a kind of isolation, a kind of loneliness that I'm not sure I can really understand. What frailties, what demons drove him to such lengths? His story would have been long, fascinating and sorrowful to hear, I am sure. But he wasn't inclined to share it.

Seventy-five years and not a single person who gives a shit about you. What a legacy of failure for a lifetime's efforts. No wonder he wanted to lose himself in drink. But really, he wasn't so different from many of the others who pass through our doors for a few hours. He just had lived longer. Most of the 40- and 50-year old homeless alcoholics are the same, they just meet their ends sooner due to the elements or the drink or violence or accident. They don't make it to a diamond anniversary.

I have a couple of uncles who succumbed to alcoholism, lost their careers and families and everything, winding up on the street. I've watched my cousins go through the cycles of anger and regret and forgiveness. They wanted to badly to save their dads, and they couldn't save them from themselves no matter how they tried. And so it was with the guy in room 8. He got his sammich, some vitamins and juice, and he was off to fend for himself, and there was nothing we could do for him except be here for him when he needs it.

Of all the sad things we see in the ER -- and there are plenty -- this seem to me to be one of the saddest and least appreciated, and by far among the most common.

10 comments:

Once in a while we deal with potential organ donors who have no family or friends...no legal next-of-kin to speak to. There's a clear-cut mechanism in place for handling this (involving the county medical examiner or public health officer, depending on the circumstances) but I can't get out of my mind the idea that these people die *alone*, with no one to care about them. These are some of the saddest cases I see. Everyone should have someone who cares whether he lives or dies.

SF, that is a beautifully written essay. What is more, it communicates a beautiful sentiment. How marvelous that after so long at your profession you are still able to recognize what is precious in another human being; how marvelous that you are still sadden by his troubles, even when he didn't ask you to be sad.

Sometimes all we can offer - or all another person can accept - is our presence, with kindness and attention. If he decides to make a change, he may come back looking for you. He may not decide to change - but he has the choice.Kudos to you for your choice - shows that your heart has not hardened too badly in the ER.

This issue of homelessness is under-appreciated. I'm currently working on my dissertation which will focus on homelessness in Honolulu through the lens of the Institute for Homeless Services here. They call their clients "guests," and their volunteer base (which is a huge and primary force of their organization) is trained to treat everyone with dignity and kindness. I for one am excited to tackle this issue, and tell the stories of not only those who for any countless number of reasons end up categorized as homeless, but those who give their time and energy to make their community stronger.

Here's to compassion and not forgetting any person can end up out of mainstream options given the right set of circumstances.

For some reason, your post reminded me of the CTA driver who oftem drove the #36 Sedgewick route from Northwestern Station (now Ogilvie Center) through Cabrini-Green up to Fullerton and Sheffield, where I got off to go to school at DePaul. This driver had an infectiously happy spirit, which he attributed to his belief in God. He welcomed everyone aboard, young and old, regardless of color, condition, or visible, audible, and fragrant characteristics, be they good or bad. Riding the Happy Bus was always one of the highlights of my day. Everyone was treated with respect and dignity, and left feeling better than when they got on. I suspect you, too, may have ridden the Happy Bus at some point while in Chicago.

Shadowfax

About me: I am an ER physician and administrator living in the Pacific Northwest. I live with my wife and four kids. Various other interests include Shorin-ryu karate, general aviation, Irish music, Apple computers, and progressive politics. My kids do their best to ensure that I have little time to pursue these hobbies.

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